A predictive model for preterm babies born < 30 weeks gestational age who will not attain full oral feedings

Abstract

Objective Develop a model to predict gastrostomy tube (GT) for feeding at discharge in infants born < 30 weeks’ (w) gestational age (GA). Study design A single-center retrospective study at academic NICU. Total of 391 (78 GT, 313 non-GT) infants < 30 w GA admitted in 2015–2018 split into test (15–16) and validation (17–18) cohorts. Classification and regression tree analysis was used to identify predictive factors for GT. Results Several factors were associated with GT requirements. Four factors included in the model were postmenstrual age (PMA) at first oral feeding, birth GA, high-frequency ventilation exposure, necrotizing enterocolitis stage II/III. Area under the receiver operator characteristic curve was 0.944 in the test cohort, 0.815 in the validation cohort. Implementation plan based on the model was developed. Conclusions We developed a predictive model to risk-stratify infants born < 30 w GA for failing full oral feeding. We hope implementation at 38 w PMA will result in earlier placement of needed GT and discharge.

Severity of respiratory disease is correlated with time of first oral feeding and need for a gastrostomy tube at discharge in premature infants born at <30 weeks of gestation

“…11 In our original model development, although every respiratory variable was associated with the GT/no GT outcome in univariate analysis, only exposure to HFV remained in the final model. 4 We suspected that respiratory status is highly correlated to the most significant variable in However, this conclusion may be confounded because there is variability amongst NICUs regarding when infants may or may not receive oral feeding attempts. 14 For instance, our NICU policy restricted oral feeding attempts to infants who were on NC flow <0.5 LPM.…”

“…We showed that BPD is associated with an older PMAff, the most important variable in our original model describing risk for GT placement. 4 Premature infants do not have mature suck-swallow-breathe coordination, limiting their ability to orally feed. Preterm infants are prone to initiate swallowing at unsafe phases of the respiratory cycle, increasing the risk of desaturation and aspiration.…”

“…The 2‐year test cohort consisted of 204 infants born <30 w GA admitted to the NICU at the Medical University of South Carolina in 2015 and 2016. The cut‐off of 30 w GA was derived from earlier work that eliminated infants who received a GT for nonprematurity‐related reasons, such as congenital anomalies 4 . Infants who died before discharge or who were admitted after 7 days of age were excluded.…”

“…The cut-off of 30 w GA was derived from earlier work that eliminated infants who received a GT for nonprematurity-related reasons, such as congenital anomalies. 4 Infants who died before discharge or who were admitted after 7 days of age were excluded. We collected retrospective data including demographics, feeding, and other disease variables, which are reported elsewhere.…”

Feeding Problems and Long-Term Outcomes in Preterm Infants—A Systematic Approach to Evaluation and Management

“…In a prospective study conducted in Austria as part of the initiative to wean tube feeds, out of the 711 children enrolled in the cohort, 53% were preterm, and a majority (two thirds) of the preterm infants were on tube feeds since birth. The authors also reported that amongst the extreme preterm infants, 83.5% had no other diagnosis except prematurity and its complications, pointing towards a strong association between feeding tube dependency and prematurity [ 34 , 35 ].…”